| NPI | 1295719680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35 040766) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: OH 35 040766) |
| 2085N0904X Radiology Nuclear Radiology (Licence: OH 35 040766) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2011-01-05 |